Expert: Forget Detox for Substance Use Disorder

LAS VEGAS — There’s a lot more to
substance abuse disorder than physical dependence, which means that acute detox
treatment by itself isn’t an effective therapy, a researcher said here.

The real key, said Debra Gordon RN,
DNP, of the University of Washington in Seattle, in a talk here at the annual PAINWeek conference, is establishing a
relationship with patients so that behavioral changes can be implemented.

Withholding opioids from patients
with substance use disorder will not cure their addiction, she said. Moreover,
providing them with opioids will not necessarily worsen their addiction and may
help them accept behavioral therapies.

“There is no evidence that
detoxing someone in an acute situation or hospital setting is going to impact
that disease,” Gordon said in a presentation. “In fact, the evidence
seems to be they will be more at risk for using at their discharge and having
an overdose, some of that being in the prison system, but you see that in
hospitals too.”

Patients with substance use disorder
continue to use drugs despite recurrent problems in their social, workplace, or
familial spheres that occur because of their use. Many take multiple substances
and have underlying mental health disorders, both of which need to be screened
for, Gordon said.

Clinicians should also anticipate
that patients with substance abuse disorder may have had negative experiences
with the healthcare system previously, Gordon said, and asking open-ended
questions without judgment may mitigate feelings of shame or fear that prompt
them to withhold information.

Seemingly obvious physical comforts,
like turning off the lights or keeping a room quiet, also go a long way as
well, Gordon said. Cognitive behavioral therapy can also help patients change
their perception of pain and help with sleep, mood, and anxiety issues
co-occurring with substance use disorder.

Still, some patients may not be
willing to change, and others may try to use within the hospital. When
encountering patients who deny having a problem, or who recognize the disorder
but are unwilling to change, providers should focus on helping them transition
out of the hospital when the time comes and providing naloxone emergency
overdose kits to patients who may return to illicit drug use.

“Failure to engage in treatment
is not a failure,” Gordon said. “It’s part of the process and it’s
part of the disease.”

But despite the treatment options
available for patients with substance abuse, some providers may be unaware they
exist, or may be unsure of what they are authorized to provide, Gordon said.

“There are barriers in the
healthcare system in terms of the way we’ve traditionally been trained and
traditionally work in silos, and to care for this population we have to really
have a team approach,” Gordon told MedPage Today. “It’s one
thing to say stuff on paper and another to try and find out how it works in the
real world.”